Post-flood health vulnerability should be alarming

Recent assessments by the humanitarian community indicate that the post-flood health situation in Pakistan is deteriorating. Scabies, diarrhea, and respiratory tract infections are significantly increasing. Dengue fever continued taking its toll as the number of cases reached an alarming 9,402 in Punjab on Friday, October 19.

Nearly two months after the floods devastated parts of the country, stagnant water remains a major factor in health risks. Inaccessibility to proper water and sanitation facilities coupled with poor hygiene practices increases the prevalence of illness and the spread of diseases.

Pakistan’s health system is insufficient to meet the health needs of the population; public health expenditure is only 1.0% of GDP.[1] Government health facilities have the main responsibility for providing health services, but they often lack qualified staff and infrastructure. The weak health system is overburdened. Parallel to the public health system are private health facilities which are only accessible by the middle and upper classes due to cost.

Poverty is an underlying cause of inaccessibility to health care. One-third, or 58.7 million, of Pakistan’s population lives in poverty. Rural communities face a much higher prevalence of poverty, at 46%, as compared to urban areas at 18%.[2] In Pakistan’s rural communities, the average monthly household income among the lowest 40% of the population is an average of US$ 124.[3]

For poverty-stricken, rural, flood-affected communities, the post-flood health risks and inaccessibility to health care places families in extreme vulnerability. With reduced access to income, food security, and nutrition due to the loss of livelihoods and agriculture, household vulnerability is drastically increased. 61.9% of the total expenditure on health, or 90.2% of total private expenditure, is out-of-pocket expense at the household level.[4] For a family of 6 from the poorest 40% of rural households, the average family yearly income per person is approximately the same as the national average for per capita health expenditure. This means they would have to be spending more than half of their income on health care; families are not receiving the health care they need considering they are spending an average of 2.61% of their income on heath expenses.[5]

We ask for the immediate attention of donors, the humanitarian community, government, and all health stakeholders. The current vulnerability to life among flood-affected households, particularly children, the elderly, and women of child-bearing age, should be alarming. An outbreak would complicate the health situation in the affected areas, with the potential to impact both affected and non-affected populations.

A proactive health response, which includes vaccination, supply of required medicines, repair and rehabilitation of health facilities, functionalization of health facilities, and establishment / strengthening of Disease Early Warning System (DEWS), is a vital need, along with significant measures to improve public health.

[1] World Bank. World Databank; original source: World Health Organization National Health Account database